What is depression? And how can therapy help?

Have you ever spent time with a mother and baby? Ever really watched what goes on between them?

What happens when the baby cries? Does the mother patiently try to work out what is wrong? Or does she react in a different way? Does she feel so stressed herself that she shouts out in frustration? Does she leave the room for a while until she’s calmed down?

What about when the baby is finding it hard to feed? Does the mother wait calmly while the baby latches on, or does she feel so agitated herself that feeding becomes impossible?

And what about the baby who has no mother (or other dedicated carer) looking after her on a day-to-day basis, but rather spends the week in a nursery in the hands of a rotating cadre of young workers?

Why do I begin this way? What does the care of babies have to do with depression?

A great deal, it turns out. When researchers studied the brains of Romanian orphans – children who had no close bonds with adults and were often left to cry in their cots from birth – they found a ‘virtual black hole’ where most of us have an orbitofrontal cortex. This is a crucial part of the brain, enabling us to regulate our own emotions, get on with others, enjoy life and appreciate beauty.

Other researchers have found the same thing: that the early care we receive decisively affects our mental stability in later life. Research has shown that, the more attuned the caregiver to the needs of the baby, the lower the levels of the hormone cortisol in the baby’s bloodstream. If the baby is left exposed to a stressful situation for too long, then the brain becomes flooded with it. If this becomes a pattern, then the child becomes ‘hardwired’ to either produce too much or too little cortisol when confronted by stressful situations. Too much is linked to depression and fearfulness; too little to emotional detachment and aggression.

Babies cannot regulate their own stress responses, but need others to do so for them. And it is only through repeated experiences of being helped in their distress that not only are their own responses – and cortisol production – regulated by others, but they learn that others can be relied upon; that the world is not a bad place, always to be feared; and that their states of mind – and by extension, they themselves – are not ‘bad’. In later life, in other words, they are far less likely to become depressed.

But what of those who have not been so fortunate; who didn’t experience such consistent, mindful care when they were babies; and whose ‘cortisol pumps’ often feel like they are jammed open?

The good news is that psychotherapy can help. The process works on many levels. It will often feel like a struggle, but this is because distressing feelings – which were often hard to manage first time round – will be roused. This time, however, with the help of an experienced therapist, new forms of emotional regulation can be practised.

The process will also involve facing the truth about one’s experience. There may be ‘unfinished business’ – feelings of rage, for example, that you were not cared for as you needed to have been, which need to be aired properly and worked through. Gradually, over time, with enough repeated experiences of painful feelings being aired and real help experienced, it may be possible to imagine that it is possible to trust others.

Psychotherapy is not easy. It takes time, commitment and money. But, through it, some real healing can take place.